Cystic teratoma mimicking recurrent pleural effusion, complicated by Mycobacterium abscessus infection

Abstract

Teratomas of anterior mediastinum are rare. They are often slow growing, asymptomatic, and detected incidentally on chest imaging. Mycobacterium abscessus (M. abscessus) is an acid‐fast bacillus that is classified as a pathogenic “rapid growing” non‐tuberculous mycobacteria. It is an uncommon cause of human pathology, which may cause skin and soft tissue infection after skin injury following inoculation, minor trauma, and surgery. Here, we present an unusual case of benign cystic teratoma mimicking recurrent pleural effusion, which was subsequently complicated by M. abscessus infection following thoracotomy. Cystic teratoma is rare, but it needs to be considered whenever clinical and investigative work‐up fails to provide a convincing diagnosis. A combined clinical, radiological, surgical, and histopathological assessment is important to arrive at the correct diagnosis. Rapidly growing mycobacteria needs to be included in the differential diagnosis of patients with non‐resolving infected post‐thoracotomy wound and who do not respond to broad‐spectrum antibiotics.

Mediastinal cystic teratoma misdiagnosed as pleural tuberculosis: A case report and review of 53 cases revealed by pleural effusion

“…We found that mature teratoma with pleural effusion presented a high proportion in female patients during their young adult life. However, the literature search demonstrates the occurrence of mature teratoma with pleural effusion in patients as young as at 25 weeks of gestation and as old as 51 years 2,9‐61 . Respiratory symptoms are predominant and not specific which has led often to a delay in the diagnosis for as long as 2 years 2,9‐11,19,20,22,28,30,32‐60 .…”

“…However, the literature search demonstrates the occurrence of mature teratoma with pleural effusion in patients as young as at 25 weeks of gestation and as old as 51 years 2,9‐61 . Respiratory symptoms are predominant and not specific which has led often to a delay in the diagnosis for as long as 2 years 2,9‐11,19,20,22,28,30,32‐60 . The majority of studies were reported in high‐income countries.…”

Pleural effusion as a rare manifestation of mediastinal teratoma: A case report

“…Mature teratoma is one of the least common anterior mediastinal tumors which grow slowly and it is asymptomatic in most cases [1] , [2] , [3] . Nonetheless, the most common clinical symptoms of mediastinal germ cell tumors include dyspnea (25%), thoracic pain (23%), cough (17%), fever (13%), weight loss (11%), superior vena cava occlusion (6%) and extrathoracic pain (5%) [4] while pleural effusion is rarely seen in such cases [5] .…”

“…These tumors grow slowly and they don't often have any symptoms so that they are rarely specified in CXR. Chest pain, dyspnea and cough are the most common symptoms of these tumors occurring because of the pressure effects on adjacent organs [1] , [2] , [3] .…”